Nearly one-third of families with children undergoing chemotherapy for acute lymphoblastic leukemia (ALL) experience significant financial hardship during treatment, according to a recent study. ALL is the most common pediatric cancer in the United States, with about 3,000 new cases diagnosed each year. While survival rates exceed 90%, treatment often involves at least two years of multidrug chemotherapy, which can disrupt family routines and lead to increased expenses.
Dr. Daniel Zheng from Children's Hospital of Philadelphia explained that the burden on families extends beyond medical care. "That's a lot of clinic visits, hospitalizations, and disruption of a family's day-to-day life," he said. Caregivers may need to take time off work or stay with their child during hospital stays, which can impact household income and ability to cover basic living costs.
The study included children enrolled in a clinical trial for previously untreated ALL between 2017 and 2021 at eight medical centers in the U.S. and Canada. Out of those eligible, 422 families participated by completing questionnaires at four intervals over two years: within about 30 days of diagnosis and at six, twelve, and twenty-four months into treatment. The primary measure was "financial toxicity," defined as either losing at least 25% of household income or being unable to pay for housing, food, or utilities during treatment.
Results showed that by six months into treatment, nearly one-fifth of families reported new difficulties covering basic living expenses or had lost a quarter or more of their annual income since starting therapy. By the end of chemotherapy after two years, these numbers rose: 30% struggled with living expenses and 31.5% had lost significant income.
Families who started treatment without financial hardship were not immune; among these households, nearly one-quarter developed difficulty meeting basic needs and over a quarter lost substantial income during therapy.
Certain groups were more vulnerable to financial toxicity: Hispanic or non-Hispanic Black children; those who spoke languages other than English at home; single-parent households; those with public insurance such as Medicaid; and families earning less than twice the federal poverty level were all more likely to face new financial challenges during treatment.
"It was striking to us that by 24 months, nearly a third of the families were unable to meet basic living costs at some point during their child's ALL treatment," Dr. Zheng said.
He noted that because participants were limited to those enrolled in clinical trials at northeastern U.S. and Canadian centers who could complete multiple surveys over time, "Our data may underestimate the overall level of financial toxicity experienced by families with children being treated for ALL."
Ongoing research aims to find ways to reduce this burden on affected families. Two co-authors are leading studies investigating whether benefits counseling or direct cash payments can help low-income families whose children are receiving cancer care.
Dr. Zheng will present these findings on Sunday, December 7, 2025 at the Orange County Convention Center.
